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01-02-2019 | 2018 SAGES Oral

A task and performance analysis of endoscopic submucosal dissection (ESD) surgery

Authors: Berk Cetinsaya, Mark A. Gromski, Sangrock Lee, Zhaohui Xia, Doga Demirel, Tansel Halic, Coskun Bayrak, Cullen Jackson, Suvranu De, Sudeep Hegde, Jonah Cohen, Mandeep Sawhney, Stavros N. Stavropoulos, Daniel B. Jones

Published in: Surgical Endoscopy | Issue 2/2019

Abstract

Background

ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries.

Methods

We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons.

Results

The average time of the marking, injection, and circumferential cutting phases are 203.4 (σ: 205.46), 83.5 (σ: 49.92), 908.4 s. (σ: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (σ: 908.43). We also performed correlation analysis (Pearson’s test) among the performance scores of the tasks. There is a moderate positive correlation (R = 0.528, p = 0.0355) between marking scores and total scores, a strong positive correlation (R = 0.7879, p = 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (R = 0.7095, p = 0.0021) between circumferential cutting and submucosal dissection and marking scores.

Conclusions

We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.

Graphical abstract

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Title: A task and performance analysis of endoscopic submucosal dissection (ESD) surgery
Authors: Berk Cetinsaya
Mark A. Gromski
Sangrock Lee
Zhaohui Xia
Doga Demirel
Tansel Halic
Coskun Bayrak
Cullen Jackson
Suvranu De
Sudeep Hegde
Jonah Cohen
Mandeep Sawhney
Stavros N. Stavropoulos
Daniel B. Jones
Publication date: 01-02-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6379-6

At a glance: The STEP trials

Springer Medicine

A task and performance analysis of endoscopic submucosal dissection (ESD) surgery

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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